Flushing IV sites with pressor drips

[ONE-TWO--]

One if the assessments we do every 4 hours involves our IV site assessments. I'll look at the site, make sure it's not leaking/infiltrated and make sure I get proper blood return and that it flushes properly without any problems. My question is that when I have a patient with a drip like epi, Neo, etc I usually will not flush those lines because I'm afraid that will give the pt a bolus of each respective drug. Am I ok just leaving the IV site connected and assessing for infiltration/phlebitis/leaking and not flushing? My rational is that if there was a problem there then either the pump would go off or I would notice some problem at the IV site.

[BahoRN]

Yes, for an IV what you're doing is perfect. If it is a central line, draw out 10cc's, then flush.

If the drug bag empties, and you have saline flowing until you get the new bag up, you can always flush then too, just to be sure it's in the vein.

[ICUPrincessNurse]

I'm mostly hoping the vasoactives are going through a CVC and not a PIV!!!

I flush my PIVs and any ports on my CVC that I'm not currently using. If I have a drip running through it and my pump isn't beeping because flow is occluded- I let it go (Let it go...can't hold it back anymore...)!

[MunoRN, RN]

I'm mostly hoping the vasoactives are going through a CVC and not a PIV!!!

I flush my PIVs and any ports on my CVC that I'm not currently using. If I have a drip running through it and my pump isn't beeping because flow is occluded- I let it go (Let it go...can't hold it back anymore...)!

Ideally those go through a CVC, in reality they come up with these running through a PIV from the ER and from surgery in particular, anesthesia runs these through PIV's pretty regularly.

[MunoRN, RN]

I prefer to always run vasoactives along with a carrier fluid. One advantage is that you get a quicker response from titrations, but also once you stop it the remained is carried through by the carrier fluid and then all that is left is in the IV is the carrier fluid.

If this isn't the case I try to aspirate the vasoactive drug. If that isn't possible and I really need the IV I'll slowly flush it through so long as it's not contraindicated due to other factors.

[FCMike11, BSN]

I'm mostly hoping the vasoactives are going through a CVC and not a PIV!!!

I flush my PIVs and any ports on my CVC that I'm not currently using. If I have a drip running through it and my pump isn't beeping because flow is occluded- I let it go (Let it go...can't hold it back anymore...)!

Depends, we have to run Levophed through peripheral IV's all the time. It's just reality.

[StayLost, BSN, RN]

Unlike teaching hospitals with a ton of residents, I have worked in private hospitals where it's not uncommon to run pressers through a PIV- like when it's the middle of the night and there is no provider to place a central line.

My question to the OP is this: is it's really necessary to assess the patency of a PIV if you are maintaining a blood pressure with your drip running & is it a good idea to interrupt the drip to flush it?

I agree with MunoRN running vasoactive medications through a manifold/carrier line is the best, as you and not only titrate the medication but also the rate that it's delivered to the patient.

[MunoRN, RN]

If you're referring to assessing the IV while the vasopressor is still running, rather than how to flush it after it's done, we typically assess for signs of infiltration/extravasation and let the pump sense occlusion.

We don't assess for blood return as part of a routine IV assessment as it's a fairly worthless assessment. There's certainly an argument to be made for a more thorough assessment when running vesicants through a PIV by also assessing for blood return, although there really isn't any clear evidence that blood return accurately differentiates between a patent IV and an infiltrated/extravasated IV.

Another advantage of the carrier fluid is that if your IV does infiltrate/extravasate it's usually going to take some amount of fluid volume before it becomes apparent to an assessment, so if it takes 3mls instance to become noticeable it's better that those 3mls be mostly saline vs concentrated vesicant.

I presume you're assessing PIV sites running pressors much more frequently than q4°.

Likewise, you're probably using a "bomber" line for running pressors... one which flushes fantastically and aspirates blood with ease so presumably you could verify patency by aspiration through a y-connector or a stopcock, discard the small amount of blood, and then flush the blood back in... do the whole process in 30 seconds or so, never even alarm the pump, and not bolus the patient.

There's certainly an argument to be made for a more thorough assessment when running vesicants through a PIV by also assessing for blood return, although there really isn't any clear evidence that blood return accurately differentiates between a patent IV and an infiltrated/extravasated IV.

Though anecdotally, the ease and flow of the blood return helps differentiate between "I'm very confident in this line" and "this one makes me nervous." I've never had a line that aspirates with ease prove to be infiltrated though I've had plenty of tweeners that went either way.

To me, the key is comprehensive and appropriate assessment, which may or may not include any particular technique.

My first Levo infiltration was in an AC on a fat person... one of those lines that pump would dump 1/2 a liter without alarming... but I knew it was a sketchy line and literally assessed it every five minutes... the signs were subtle but they were there. I d/c'd the drip and there were no serious adverse effects as the site and we didn't even need to infiltrate with phentolamine.